Zhang Licheng, Xu Meng, He Chunqing, Du Hailong, Chen Hua, Guo Yizhu, Tao Sheng, Zhang Qun, Liang Xiangdang, Tang Peifu
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Dec;24(12):1428-31.
To investigate the surgical treatment effectiveness of acetabular transverse and posterior wall fractures by Kocher-Langenbeck approach.
Between January 2002 and February 2009, 17 patients with acetabular transverse and posterior wall fractures were treated with Kocher-Langenbeck approach and fracture reduction and fixation. There were 12 males and 5 females with an average age of 33.4 years (range, 20-65 years). The disease causes were traffic accident in 16 cases and falling from height in 1 case. The disease duration was 6 hours to 11 days. According to Letournel classification, all fractures were rated as acetabular transverse and posterior wall fractures. Concomitant injuries included posterior hip dislocation in 3 cases, fracture of extremities in 8 cases, injury of sciatic nerve in 3 cases, craniocerebral injury in 1 case, and lienal rupture in 1 case.
The incisions healed primarily and no complication of infection and deep venous thrombosis occurred after operation. All patients were followed up 12 to 36 months with an average of 19 months. The X-ray films showed that fracture healed 3 to 5 months after operation. After operation, anatomic reduction was found in 9 cases, satisfactory reduction in 5 cases, and unsatisfactory reduction in 3 cases according to Matta et al criterion. According to modified grading system of Merle D'Aubigne and Postel, the results were excellent in 4 cases, good in 9, fair in 3, and poor in 1 at last follow-up with an excellent and good rate of 76.5%. The nerve function was recovered in patients with sciatic nerve injury at 12 months after symptomatic treatment. Traumatic arthritis occurred in 5 cases, avascular necrosis of the femoral head in 1, and heterotopic ossification in 5 between 9 weeks and 12 months after operation.
For acetabular transverse and posterior wall fractures, it is important to make adequate preoperative preparation, to get the imaging data, and to perform open reduction and internal fixation with Kocher-Langenbeck approach as early as possible.
探讨采用Kocher-Langenbeck入路治疗髋臼横形及后壁骨折的手术疗效。
2002年1月至2009年2月，对17例髋臼横形及后壁骨折患者采用Kocher-Langenbeck入路行骨折复位内固定术。其中男12例，女5例，平均年龄33.4岁（20～65岁）。致伤原因：交通事故16例，高处坠落1例。病程6小时至11天。按Letournel分类，均为髋臼横形及后壁骨折。合并伤包括：髋关节后脱位3例，四肢骨折8例，坐骨神经损伤3例，颅脑损伤1例，脾破裂1例。
切口一期愈合，术后无感染及深静脉血栓形成等并发症。所有患者均获随访，随访时间12～36个月，平均19个月。X线片示术后3～5个月骨折愈合。按Matta等标准，术后解剖复位9例，满意复位5例，不满意复位3例。按Merle D'Aubigne和Postel改良评分系统，末次随访时优4例，良9例，可3例，差1例，优良率76.5%。坐骨神经损伤患者经对症治疗后12个月神经功能恢复。术后9周～12个月出现创伤性关节炎5例，股骨头缺血性坏死1例，异位骨化5例。
对于髋臼横形及后壁骨折，术前充分准备、获取影像学资料，尽早采用Kocher-Langenbeck入路切开复位内固定至关重要。
